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					Orthopedic technology, brace therapy · Conservative therapy                                                      D 02


 Orthopedic technology, brace therapy




                                                                                                                        Spine Surgery Information Portal · Prof. Dr. Jürgen Harms · www.harms-spinesurgery.com
 The earliest descriptions of a brace, or corset, therapy for scoliosis go back to Hippocrates, and the French
 army surgeon Ambroise Paré (1510-1590) developed a supporting device made of iron plates in the Middle
 Ages.
 Since the Milwaukee brace was developed by Blount in 1945, a variety of further developments and
 modifications	of	corsets	have	become	an	established	element	of	conservative	scoliosis	therapy.	The	objective	of	
 brace therapy is to prevent the further progression of the spinal column curvature and to straighten an existing
 pathological curvature to some degree.
 Scoliosis therapy using a brace or corset worn for a longer period of time is a heavy burden, both mental and
 physical, to place on a growing young person, who has to deal with it on a day-to-day basis. Successful therapy
 in such cases depends on intensive supervision and support from both parents and therapists.
 Brace therapy can only succeed if the following factors are considered:
 · Selection of the correct brace
 · Correct brace structure
 · Inspection at regular intervals so adjustments can be made
 · The patient must understand the situation and be willing to cooperate completely
 · Intensive, comprehensive support by family and therapists
 Back brace therapy for scoliosis has been controversial for a number of years. The international
 recommendations are not uniform.
 The	decision	to	use	a	back	brace	is	often	questionable	since	the	efficiency	of	this	treatment	is	far	from	proven.	
 In contrast, it has been conclusively proven that a highly progressive (worsening) scoliosis cannot ultimately be
 influenced	by	a	back	brace	at	all!
 See the “Deformities, scoliosis” chapter for the therapeutic objectives for scoliosis therapy set by our
 department.

 Below are brief descriptions of the different types of back braces available.



 The Milwaukee brace (CTLSO = cervico-thoraco-lumbo-sacral orthosis)

 The Milwaukee brace was developed in 1945 by Blount in the US. It consists of a molded plastic pelvic girdle
 connected by aluminum bars in the front and back to a closed neck ring. The neck ring closes at the back with a
 screw where the support pad for the back of the head is located. There is a padded hollow for the chin to rest in
 at the front. Spinal malposition is corrected by the insertion of additional pressure pads.

 The brace is supposed to result in active extension, derotation, and lordosis adjustment. Milwaukee back brace
 treatment is accompanied by special physiotherapeutic exercises performed in the brace. The drawbacks of the
 brace include a pronounced lordotic effect on the thoracic spine and discomfort due to the neck ring.

 Today, the Milwaukee brace is normally used only to treat upper thoracic scoliosis.




           Prof. Dr. med. Jürgen Harms · Klinikum Karlsbad-Langensteinbach · Guttmannstraße 1 · 76307 Karlsbad
                                                                                                                  1
                                  © www.harms-spinesurgery.com 2007. All rights reserved.
Orthopedic technology, brace therapy · Conservative therapy                                                       D 02


 Underarm braces (TLSO = thoraco-lumbo-sacral orthosis)




                                                                                                                         Spine Surgery Information Portal · Prof. Dr. Jürgen Harms · www.harms-spinesurgery.com
 Underarm braces have no neck ring and are the successor to the Milwaukee brace. In TLSOs, built-in pads
 exert pressure on the spinal column at three points to apply the corrective force necessary to improve the
 malposition	of	the	spinal	column.	These	so-called	three-point	corsets	are	fitted	with	pressure	pads	along	the	
 lumbar spine, around the outer pelvis and along the ribcage.
 The Boston, Chêneau and Lyon (Stagnara) derotation braces are examples of this type of orthosis.



 Boston brace

 The Boston brace is a further development of the Milwaukee brace.
 The brace is made of plastic molded using a plaster cast. Integrated pads are intended to achieve a partially
 active correction of the spinal column malposition.
 The	first	Boston	brace	models	featured	pronounced	delordosing	of	the	lumbar	spine,	though	this	proved	to	be	
 disadvantageous. The brace’s modular structure has allowed for the development of a number of variations
 of the Boston brace with lumbar lordosis up to a Cobb angle of 15°. This is a decisive feature when it comes
 to correcting a malposition, since the only way to achieve kyphosis of the thoracic and thoracolumbar spine is
 through physiological lumbar lordosis. The combined effect of the modules and integrated pressure pads are
 intended to both straighten and derotate the spinal column.
 The Boston brace is normally used in the treatment of lumbar and thoracolumbar scolioses.



 Chêneau brace

 The	Chêneau	brace	was	developed	in	the	mid-seventies	by	the	French	physician	Jacques	Chêneau.
 The orthosis is made of plastic molded using a plaster cast, featuring a pelvic corset that pushes the pelvis into
 an upright position and allows for traction to stretch the lumbar spine.
 The Chêneau brace is a partially active inspiration-derotation brace, i. e. correction of the existing spinal
 malposition is achieved through pad pressure, the voids in the orthosis serve as compensatory spaces, and a
 special	respiratory	technique	is	learned	as	a	part	of	this	treatment	method.	The	Chêneau	brace	is	normally	used	
 for the conservative treatment of idiopathic thoracic scoliosis.



 Lyon or Stagnara brace

 This brace provides high shoulder support for torso extension, i.e. its upper structure reaches up high beneath
 the shoulders to provide support. The pelvic girdle and auxiliary supports are connected in the front and back by
 aluminum rods. The integrated pressure pads are used to achieve derotation.
 The Stagnara brac can be used in treatment of thoracolumbar and mid-level thoracic scolioses.



 Wilmington brace

 This	brace	is	made	of	thermoplastic	material	and	is	mainly	used	for	thoracolumbar	scolioses	without	a	fixed	
 rotary pivot of the spinal column.




           Prof. Dr. med. Jürgen Harms · Klinikum Karlsbad-Langensteinbach · Guttmannstraße 1 · 76307 Karlsbad
                                                                                                                   2
                                  © www.harms-spinesurgery.com 2007. All rights reserved.
Orthopedic technology, brace therapy · Conservative therapy                                                      D 02


 Charleston bending brace




                                                                                                                        Spine Surgery Information Portal · Prof. Dr. Jürgen Harms · www.harms-spinesurgery.com
 This is a bending, or sidebending, brace. In contrast to the orthoses described above, here a bending force acts
 upon the spinal column malposition. When wearing the brace, the patient is held in a maximum counterlateral
 bend, i.e. countering the malcurvature to be treated. An integrated pressure pad exerts pressure at the apex of
 the curvature, thus achieving a rebending effect on the scoliotic deformity. The brace is intended to be worn for
 8 hours during the night and is used for treatment of short thoracolumbar or lumbar scolioses.



 Lukeschitsch bending brace

 A pressure pad in the pelvic girdle of this brace design exerts pressure on the lumbar vertex of the scoliotic
 malcurvature. Pressure pads can be continuously positioned and adjusted along the front and back aluminum
 rods of the brace. These pressure pads serve to derotate and straighten the spinal column.




           Prof. Dr. med. Jürgen Harms · Klinikum Karlsbad-Langensteinbach · Guttmannstraße 1 · 76307 Karlsbad
                                                                                                                  3
                                  © www.harms-spinesurgery.com 2007. All rights reserved.

				
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